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Original research article
Chocolate consumption and risk of cardiovascular diseases: a meta-analysis of prospective studies
  1. Yongcheng Ren1,
  2. Yu Liu1,
  3. Xi-Zhuo Sun1,
  4. Bing-Yuan Wang2,3,
  5. Yang Zhao2,3,
  6. De-Chen Liu2,3,
  7. Dong-Dong Zhang3,
  8. Xue-Jiao Liu3,
  9. Rui-Yuan Zhang2,3,
  10. Hao-Hang Sun3,
  11. Fei-Yan Liu2,
  12. Xu Chen3,
  13. Cheng Cheng3,
  14. Lei-Lei Liu3,
  15. Qiong-Gui Zhou2,
  16. Ming Zhang2,
  17. Dong-Sheng Hu1,2
  1. 1The Affiliated Luohu Hospital, Shenzhen University Health Science Center, Shenzhen, China
  2. 2Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, China
  3. 3Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
  1. Correspondence to Professor Dong-Sheng Hu, The Affiliated Luohu Hospital of Shenzhen, University Health Science Center, Shenzhen 518001, China; dongshenghu563{at}


Objective Studies investigating the impact of chocolate consumption on cardiovascular disease (CVD) have reached inconsistent conclusions. As such, a quantitative assessment of the dose–response association between chocolate consumption and incident CVD has not been reported. We performed a systematic review and meta-analysis of studies assessing the risk of CVD with chocolate consumption.

Methods PubMed and EMBASE databases were searched for articles published up to 6 June 2018. Restricted cubic splines were used to model the dose–response association.

Results Fourteen publications (23 studies including 405 304 participants and 35 093 cases of CVD) were included in the meta-analysis. The summary of relative risk (RR) per 20 g/week increase in chocolate consumption was 0.982 (95% CI 0.972 to 0.992, I2=50.4%, n=18) for CVD (heart failure: 0.995 (0.981 to 1.010, I2=36.3%, n=5); total stroke: 0.956 (0.932 to 0.980, I2=25.5%, n=7); cerebral infarction: 0.952 (0.917 to 0.988, I2=0.0%, n=4); haemorrhagic stroke: 0.931 (0.871 to 0.994, I2=0.0%, n=4); myocardial infarction: 0.981 (0.964 to 0.997, I2=0.0%, n=3); coronary heart disease: 0.986 (0.973 to 0.999, n=1)). A non-linear dose–response (pnon-linearity=0.001) indicated that the most appropriate dose of chocolate consumption for reducing risk of CVD was 45 g/week (RR 0.890;95%CI 0.849 to 0.932).

Conclusions Chocolate consumption may be associated with reduced risk of CVD at <100 g/week consumption. Higher levels may negate the health benefits and induce adverse effects associated with high sugar consumption.

  • heart failure
  • epidemiology
  • meta-analysis
  • stroke

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  • Contributors Substantial contributions to the conception and design of the work: D-SH, Y-CR, D-DZ and X-JL. Acquisition, analysis and interpretation of data for the work: Y-CR, D-DZ, X-JL, YL, X-ZS and D-SH. Drafting the work and revising it critically for important intellectual content: Y-CR, D-DZ, X-JL, YL, X-ZS, B-YW, YZ, D-CL, R-YZh, H-HS, F-YL, XC, CC, L-LL, Q-GZ, MZ and D-SH. Final approval of the version to be published: Y-CR, YL, X-ZS, B-YW, YZ, D-CL, R-YZ, H-HS, F-YL, D-DZ, X-JL, XC, CC, L-LL, Q-GZ, MZ and D-SH.

  • Funding This study was supported by the National Natural Science Foundation of China (grant nos. 81373074, 81402752 and 81673260); the Natural Science Foundation of Guangdong Province (grant no. 2017A03013452); the Medical Research Foundation of Guangdong Province (grant no. A2017181); and the Science and Technology Development Foundation of Shenzhen (grant nos. JCYJ20140418091413562, JCYJ20160307155707264, JCYJ20170412110537191), the Natural Science Foundation of Shenzhen University (grant no. 201404; JCYJ 20170302143855721 and JCYJ20170412110537191), and the Natural Science Foundation of Shenzhen University (grant no. 201404).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.